The Costs Associated with Antidepressant Use in Depression and Anxiety in Community-Living Older Adults

Vasiliadis, Helen‐Maria; Latimer, Éric; Dionne, Pierre; Préville, Michel

doi:10.1177/070674371305800405

Cited by 17 publications

(17 citation statements)

References 45 publications

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“…In the elderly, antidepressant use is associated with increased risk of strokes, falls, fractures, hyponatraemia and death (Coupland et al, 2011). It also results in substantial healthcare costs (Health and Social Care Information Centre, 2017; Vasiliadis et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Maund

Dewar-Haggart

Williams

et al. 2019

Journal of Affective Disorders

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Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Maund

Dewar-Haggart

Williams

et al. 2019

Journal of Affective Disorders

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“…[6][7][8] This inappropriate use exposes patients to potentially serious adverse effects 9,10 and is costly. 11 Stopping antidepressants, however, is frequently associated with withdrawal symptoms, which can be problematic, and mistaken for relapse/ recurrence. 12 To minimize these symptoms, the American Psychiatric Association and the National Institute for Health and Care Excellence advise tapering doses over some weeks in most cases.…”

Section: Introductionmentioning

confidence: 99%

Managing Antidepressant Discontinuation: A Systematic Review

et al. 2019

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PURPOSE We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients. METHODSWe conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function. RESULTSOf 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18-0.67; 2 studies). Relapse/ recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies). CONCLUSIONSCognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

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“…Canadian healthcare costs are generally lower than those in the US. Nonetheless, a recent population-based study from the province of Quebec found that overall healthcare costs were approximately $2,000 (CAD) higher for patients prescribed antidepressants, with a large proportion of increased costs attributed to patients without a recent history of depression or anxiety [54]. The cost of treatment, however, is only part of the cost of screening.…”

Section: Discussionmentioning

confidence: 99%

There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: a systematic review

Thombs

Ziegelstein

Roseman

et al. 2014

BMC Med

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BackgroundThe United States Preventive Services Task Force (USPSTF) recommends screening adults for depression in primary care settings when staff-assisted depression management programs are available. This recommendation, however, is based on evidence from depression management programs conducted with patients already identified as depressed, even though screening is intended to identify depressed patients not already recognized or treated. The objective of this systematic review was to evaluate whether there is evidence from randomized controlled trials (RCTs) that depression screening benefits patients in primary care, using an explicit definition of screening.MethodsWe re-evaluated RCTs included in the 2009 USPSTF evidence review on depression screening, including only trials that compared depression outcomes between screened and non-screened patients and met the following three criteria: determined patient eligibility and randomized prior to screening; excluded patients already diagnosed with a recent episode of depression or already being treated for depression; and provided the same level of depression treatment services to patients identified as depressed in the screening and non-screening trial arms. We also reviewed studies included in a recent Cochrane systematic review, but not the USPSTF review; conducted a focused search to update the USPSTF review; and reviewed trial registries.ResultsOf the nine RCTs included in the USPSTF review, four fulfilled none of three criteria for a test of depression screening, four fulfilled one of three criteria, and one fulfilled two of three criteria. There were two additional RCTs included only in the Cochrane review, and each fulfilled one of three criteria. No eligible RCTs were found via the updated review.ConclusionsThe USPSTF recommendation to screen adults for depression in primary care settings when staff-assisted depression management programs are available is not supported by evidence from any RCTs that are directly relevant to the recommendation. The USPSTF should re-evaluate this recommendation.Please see related article: http://www.biomedcentral.com/1741-7015/12/14RegistrationPROSPERO (#CRD42013004276)

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The Costs Associated with Antidepressant Use in Depression and Anxiety in Community-Living Older Adults

Cited by 17 publications

References 45 publications

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis

Managing Antidepressant Discontinuation: A Systematic Review

There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: a systematic review

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